title: Midterm follow-up of arterial switch operation for transposition of the great arteries with intact ventricular septum and left-ventricular outflow tract obstruction.
abstract: OBJECTIVE
  We report the mid-term follow-up of patients, who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA) with intact ventricular septum and left-ventricular outflow tract obstruction (LVOTO) over a 10-year period from 2000 to 2009.
  
  
  METHODS
  Thirteen TGA patients (3.9% of our ASO cohort) with intact ventricular septum and LVOTO underwent ASO. LVOTO was defined as pulmonary valve z-score ≤ -2.0 (n=3) or peak LVOT gradient ≥40 mmHg with (n=7) or without (n=3) anatomic subvalvar stenosis on echocardiography. Median age and weight were 14 days (range, 7-130 days) and 3.2 kg (range, 2.1-4.6 kg). The LVOT abnormalities included fibromuscular narrowing (n=5) and atrioventricular valve-related findings (n=5). LVOT clearance was achieved by resection of accessory mitral tissue (n=2) only.
  
  
  RESULTS
  Follow-up was 100% complete. There were no early or late deaths. Freedom from re-operation for neo-aortic valve regurgitation and/or LVOTO was 100% at a median follow-up of 38 months (range, 6-115 months). All patients had functional status appropriate for their age. Three patients had mild aortic regurgitation. The median Doppler estimated LVOT systolic gradient was 12 mmHg (range, 0-18 mmHg) for the entire cohort at the latest follow-up.
  
  
  CONCLUSIONS
  Mid-term outcomes of ASO for a highly selected group of patients with pulmonary valve annulus z-score ≤ -2.0 ≥ -0.4, resectable organic LVOTO, and dynamic peak LVOT gradient ≥40 mmHg remain satisfactory, with a need for long-term follow-up.
authors.affiliation: Department of Paediatric Cardiothoracic Surgery, Great Ormond Street Hospital, London, WC1N 3JH, UK. drrajashahzad@hotmail.com
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.forename: Martin
authors.initials: M
authors.lastname: Kostolny
authors.forename: Nilesh
authors.initials: N
authors.lastname: Oswal
authors.forename: Ahmed
authors.initials: A
authors.lastname: Afifi
authors.forename: Branko
authors.initials: B
authors.lastname: Mimic
authors.forename: Ian D
authors.initials: ID
authors.lastname: Sullivan
authors.forename: Marc R
authors.initials: MR
authors.lastname: de Leval
authors.forename: Victor T
authors.initials: VT
authors.lastname: Tsang
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging; D018450:Disease Progression; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*